Title I, Part D Neglected or Delinquent Program
Office of School Improvement and Community Services (NYC)
Desk Audit Protocol
School Year 2014 -15
1. Type of Facility:Neglected Delinquent / 2. Does organization have multiple facilities?
Y N / NOTE: If Yes, a Desk Audit Protocol Report must be completed for each facility. Attach name and address for all sub-sites to the Report submitted by the main (umbrella) site.
3. Name of Facility: / 4. Facility Address: / 5. Facility Contact Name:
6. Facility Contact Phone # / 7. Facility Contact E-Mail / 8. Facility Contact Fax #:
9. LEA Contact: / 10. LEA Contact Phone # / 11. LEA Contact Fax #
12. Facility Capacity: / 13. Gender of students in residence:
M F / 14. Students average age range:
___ to ___ / 15. Average length of stay for residents in facility
______/ 16. Do students receive core instruction on site?
Yes No
17. # of hours of direct core instruction provided per week:______/ 18. # of hours of supplemental instruction provided per week:______/ 19. # of staff paid through Title I, Part D funds:______/ 20. Number of Students in Residence
2014-15 School Year:
______/ 21. Number of Long –Term Students (Students in residence in 90 Days)
2014-15 School Year:
______
Please address indicators 1- 4, below, on separate pages and sign the certification.
1. FORMAL AGREEMENT[Legal Reference NCLB §1423 (2)]
A formal agreement must be in place between the Local Education Agency (LEA)-School District, the facility and the agency providing educational services. This agreement should outline the roles and responsibilities of each entity involved in the Title I, Part D program operated at the facility.
A)Provide a copy of the signed and dated formal agreement.
B)Sample formal agreements[see link]
2. TITLE I, PART D PROGRAM EVALUATION [Legal Reference: NCLB § 1431(a)]
The facility/LEA/program evaluates its project(s) to determine the impact of the Title I, Part D funding on students. The data are disaggregated by gender, race, ethnicity, and age, at a minimum.
A)Provide a detailed narrative description that describes the facility’s program evaluation plan;
B)Describe themost recent results of the facility’s program evaluation, including disaggregated data;
C)Explain how the results will be used to plan and improve the educational program;
D)Provide a sample of assessment tools.
3. TRANSITION (INTAKE/DISCHARGE) PROCEDURES:
The facility has formal written transition procedures. These procedures outline the steps that need to be taken to bring a student into the facility and leave the facility in a seamless fashion.
A)Provide a copy of the intake and discharge procedures that are implemented at the facility.
4. TITLE I, PART D INVENTORY LISTING:
The facility and LEA must maintain an inventory listing of all Title I, Part D (funding source) property/equipmentpurchases that include a product description, serial number, acquisition cost and date, location and equipment disposal date
A)Provide a copy of the Title I, Part D Inventory Listing for the facility from the 2014-15 school year.
B)Title I, Part D Inventory Sample/Template: [see link]
I CERTIFY that the information provided on this survey is, to the best of my knowledge, complete and accurate. A knowingly false claim on this report is a criminal offense under U.S. Code, Title 18, Section 1001 or Section 387.Authorized Signature (in blue ink) / Title:
Typed Name: / Date: